目的:探讨脑卒中后患者淡漠状态对脑卒中后康复影响.方法:选取住院患者92例,并对所有患者抑郁及淡漠状态进行主观量表和客观量表进行评估,使用抑郁、淡漠作为两因素方差分析患者功能康复的影响.结果:部分病人抑郁和淡漠状态共存,合并淡漠状态的抑郁症患者的客观评分更高,抑郁患者客观MADRS评分比主观SDS评分明显增高(P<0.05),患者第二次评估时客观评估评分较首次明显下降(P<0.05).两因素方差分析显示淡漠状态对患者对与患者FIM评分有明显影响(P<0.05),客观量表显示抑郁对患者运动功能恢复(FIM评分)为主要影响因素.结论:客观量表对脑卒中患者心理状态评估具有重要作用,卒中后抑郁患者患者的淡漠状态对患者抑郁及功能康复具有明显影响.

目的 探讨奥拉西坦联合帕罗西汀治疗卒中后抑郁患者的临床效果.方法 选取于2013年9月-2015年10月在我院接受治疗的脑梗塞恢复期轻度认知功能障碍患者共84例,随机分为观察组和对照组.分别给予对照组胞二磷胆碱和帕罗西汀治疗,观察组奥拉西坦和帕罗西汀治疗三周.观察临床治疗效果.结果 观察组治疗三周后的蒙特利尔评分为(27.62±3.14)分,不良反应率为7.1%,均优于对照组,组间比较有差异(P<0.05).结论 奥拉西坦联合帕罗西汀用于治疗卒中抑郁患者,能够改善卒中后抑郁患者的抑郁程度,提高患者认知功能水平,且具有较高的安全性.

目的分析慢性阻塞性肺疾病(COPD)合并脑梗死患者的临床特点,提高对该病的认识。方法对36例COPD合并脑梗死患者及30例单纯脑梗死患者临床资料及血液流变学指标、临床疗效进行比较。结果 COPD合并脑梗死组较单纯脑梗死组临床表现不典型,血红蛋白、全血黏度、血浆黏度、红细胞压积、血小板黏附率明显升高,临床治疗总有效率明显降低。结论对于COPD患者出现精神神经症状应注意合并脑梗死可能并注意鉴别,早期给予综合干预可预防病情恶化及减少误诊。

Objective To investigate the electrophysiological changes of peripheral nerves in both patients with hereditary neuropathy with liability to pressure palsies(HNPP).Methods The nerve conduction velocities of a family consisting of a proband and 4 members were tested,and the proband was detected by biopsy.Results The proband's median nerve,ulnar nerve,sural sensory nerve conduction velocity (SCV) were decreased.The median nerve,ulnar nerve,common peroneal nerve motor nerve conduction velocity(MCV) of proband were decreased.The sensory fibers of the most frequently involved nerve sural nerve,sural nerve damage to the results:the motor nerve conduction motor nerve evoked potential latency and 18 abnormal rate was 75.0％,the nerve distal to the abnormal rate of MCV was 87.5％.Conclusion Prolongation of distal nerve conduction latencies occurs in essentially all individuals whether symptomatic or asymptomatic.Nerves may be more easily damaged at the site of compression.

The objective of this study was to evaluate the brain function characteristics of carbon monoxide poisoning patients using resting-state functional magnetic resonance imaging (fMRI) method. For this purpose, 12 carbon monoxide poisoning patients and healthy controls were subjected to resting-state fMRI scans separately. A regional homogeneity (ReHo) approach was used to analyze the brain function in carbon monoxide poisoning patients. Compared with control group, the value of ReHo in carbon monoxide poisoning group showed distinct decrease in bilateral superior frontal gyrus, middle frontal gyrus, right cuneus, left middle temporal gyrus, right insula, and cerebellum. Therefore, it was concluded that the brain functions in carbon monoxide poisoning patients were abnormal under the resting-state. The cuneate lobe function may indicate the degree of brain hypoxia and strengthening the cerebellar function training may promote the rehabilitation process.

目的提高对痴呆样改变的巨幼细胞性贫血患者的认识。方法 30例患者均以痴呆为首发表现,常规行韦氏量表测智商(IQ)、长谷川痴呆量表(HDS)和简易智能状态检查表(MMSE)评定认知功能,并测定血清维生素B12(VitB12)或叶酸及骨髓象检查,确诊后给予甲基VitB12。结果以痴呆样改变的巨幼细胞性贫血患者IQ、HDS、MMSE评分明显低,血清VitB12和/或叶酸低,经给予VitB12痴呆症状迅速缓解。结论临床对于痴呆样改变患者,应常规监测血清VitB12和/或叶酸,必要时骨髓象排除巨幼细胞性贫血所致。

Objective To investigate the brain function in the patients with transient ischemic attack (TIA) using index of regional homogeneity ( ReHo ).Methods Sixteen TIA patients ( TIA group ) and 16 age-matched normal controls (control group) underwent standard resting state functional MRI (fMRI)scan.The changes of the brain ReHo were studied by DPARSF analysis.Results Compared with that of control group,TIA group showed significantly decreased ReHo in the left cingulate gyrus (z =-3.72),left frontal gyrus (z =-3.02),right frontal gyrus (z =-3.23),right superior frontal gyrus (z =-3.75),right precuneus (z =-3.80),right inferior parietal lobule (z =-3.98 ),left inferior parietal lobule (z =-3.82),precentral gyrus ( z =- 3.85 ),right midfrontal gyrus ( z =-4.15 ),right midtemporal gyrus (z =- 3.43 ),and increased ReHo in the right hippocampus (z =3.37) and right cerebellum (z =3.55).Conclusion The rest-state brain function is abnormal in TIA interictal phase,and the increased ReHo in the hippocampus and cerebellum may reflect stress-induced brain protection of TIA and partial comoensatory response.

目的观察联合应用复方血栓通胶囊与阿司匹林对阿司匹林抵抗发生率的影响。方法将243例明确诊断急性脑梗死患者分为阿司匹林组(n=81)和联合应用组(n=78)。阿司匹林组:拜阿司匹林100 mg,1次/d口服。联合应用组:复方血栓通胶囊1.5 g,3次/d口服;并阿司匹林100 mg,1次/d口服。分析治疗2周后阿司匹林聚集率,使用2检验分析组间阿司匹林抵抗发生率的差异。结果阿司匹林组及联合应用组在同一诱导剂下均存在阿司匹林抵抗,联合应用组在花生四烯酸诱导下与阿司匹林组比较差异无统计学意义;在二磷酸腺苷诱导下,与阿司匹林组比较差异有统计学意义。治疗后,联合应用组抵抗率低于阿司匹林组,差异有统计学意义。结论联合使用复方血栓通胶囊及阿司匹林,能有效降低阿司匹林抵抗发生率,对改善缺血性卒中预后有一定意义

Objective To investigate any changes in motor functional connectivity in the brains of acute ischemic stroke patients after low frequency electrical stimulation.Methods Twenty-five ischemic stroke patients were given low frequency electrical stimulation in addition to their conventional rehabilitation treatment.Another 20 patients received only conventional treatment as a control group.Resting-state functional magnetic resonance imaging (rs-fMRl)was employed to assess motor function connectivity in the brains of all 45 subjects before and after treatment.Any differences in functional impairment,extremity motor function or ability in the activities of daily living were also recorded before and after treatment.Results In both groups,average scores on the Canadian neurological scale (CNS)and the National Institutes of Health stroke scale (NIHSS) had been reduced significantly after treatment and FuglMeyer assessment (FMA) and modified Barthel index (MBI) scores had significantly increased.The average improvements in terms of FMA and MBI scores were significantly greater in the observation group.Compared with before treatment,the coefficient of functional connectivity of the bilateral motor cortex had decreased significantly after treatment in both groups.In the observation group the changes were significantly correlated with the improvements in FMA scores.Conclusion Neural functional impairment after ischemic stroke can be reduced significantly and extremity motor function and ability in the activities of daily living can be significantly improved by low frequency electrical stimulation.

Objective To investigate the effect of platelet leukocyte aggregations(PLA) in patients with acute cerebral infarction by using Compound Xueshuantong.Methods 52 patients with acute cerebral infarction were randomly divided into Aspirin group and Compound Xueshuantong group.The changes of circulating PLA before treatment and 2 weeks after treatment were analyzed.Results After treatment,Aspirin group showed the PLyA,PMA,PNA and PLA were decreased,but there was no statistically significant difference before and after treatment(P 0.05),while the PLyA,PMA,PNA and PLA had a significant statistically difference in Compound Xueshuantong group.Compared with Aspirin group,the PMA and PLA had a statistically significant difference(P 0.01),but PNA had no statistically significant difference(P 0.05).Conclusion Combined use of Compound Xueshuantong and Aspirin can reduce the platelet activation function and improve prognosis,which is of positive significance in patients with cerebral infarction.

患者女性,65岁.2010年1月因食欲不佳伴全身乏力4d就诊于感染科.患者最近未服用任何肝毒性或神经毒性药物,无疫苗接种,无感冒、腹泻,近半年来未外出.入院查体:血压150/90 mm Hg(1 mm Hg=0.133 kPa),神清,精神萎,扶入病房,全身皮肤、黏膜轻度黄染,无皮疹、瘀点,浅表淋巴结无肿大,心肺正常,腹软,肝区叩痛(+),肝脾肋下未及,颅神经(-),四肢肌力、肌张力正常,双侧腱反射对称,病理反射(-),深浅感觉正常.查肝功能示:天冬氨酸转氨酶(AST) 1054 U/L,谷氨酰转肽酶(rGT) 372 U/L,丙氨酸转氨酶(ALT) 1330 U/L,总胆红素(TB) 14.2 μmol/L,白蛋白(ALB)38.0 g/L.入院后给予护肝以及对症支持等治疗,甲型肝炎抗体(-)、丙型肝炎抗体(-)、乙型肝炎病毒血清学指标均(-),戊型肝炎抗体(+),抗-HEV-IgM(+),抗-HEV-IgG(+),肾功能、血糖、电解质均正常.诊断为戊型肝炎.

Objective To detect the fiber structure and volume differences in frontal lobe between patients with amnestic mild cognitive impairment (aMCI) and normal control.Methods T1 -weighted magnetic resonance imaging and diffusion tensor imaging were obtained in 28 aMCI patients and 25 normal controls.Volumes,fiber fractional anisotropy (FA),fiber apparent diffusion coefficient (ADC),fiber number,and average fiber length of frontal lobe in the two groups were measured.Results Volumes of left frontal lobe ( ( 337.35 ± 20.45 ) cm3 ) in aMCI group were smaller than control ( (358.54 ± 27.26) cm3 ) ( t =- 3.223,P =0.002 ).Numbers of short range fiber in left frontal lobe ( 16985 ± 892) were significantly increased relative to control ( 16387 ±752) ; while numbers of long range fiber (3214 ± 185 ) were reduced compared with control (3425 ± 277 ),and ADC values increased ( t =2.621,P =0.012; t =-3.714,P =0.001 ; t =17.595,P=0.000).In aM CI group,numbers of long range fiber in right frontal lobe were reduced (2895 ± 343 vs.3451 -± 230,t =- 7.011,P =0.000),and ADC values were increased ( t =4.443,P =0.000).In aMCI group,numbers of long range fiber in left frontal lobe were positively correlated with scores of mini-mental state examination ( MMSE ) ( r =0.457,P =0.015 ),while ADC values of long range fiber in left frontal lobe were negatively correlated with scores of MMSE ( r=-0.415,P=0.028).Conclusion The structure and fiber connectivity are affected in aMCI patients and the lesion of connectivity in left frontal lobe are related to the severity of symptom.

先证者(Ⅱ2) 女,49岁.主因双下肢麻木、无力反复发作10余年人院.于久坐或提重物后发作,主要症状为小腿前外侧及后侧、足背麻木,抬脚费力,足趾不能背曲.发病初症状时重时轻,能自行缓解,查体:颅神经无异常,双侧腓浅神经分布区痛觉减低,深感觉减退,双足及足趾不能背曲,足不能外展.四肢腱反射对称减低,病理征未引出.余神经系统检查均正常。

To investigate spatial patterns of intrinsic neural activity of depressed patients with vascular risk factors using resting-state functional magnetic resonance imaging (fMRI) and to examine the relationship between regional activity abnormalities and symptom severity factor, we analyzed spatial patterns of spontaneous brain activity in 19 depressed patients with vascular risk factors and 18 healthy subjects. Intrinsic brain activity was measured by the amplitude of low-frequency fluctuations (ALFF) of the resting-state blood oxygen level dependent signal. Depressed patients with vascular risk factors showed decrease in ALFF in the limbic-cortical-striatal-pallidal-thalamic circuit. Specifically, the altered ALFF values (i.e., left insula and right superior frontal gyrus) were significantly correlated with depression severity in the depressed group. In addition, higher ALFF values in the right middle temporal gyrus and right superior temporal gyrus were observed in depressed patients with vascular risk factors. Our findings reveal distinct functional patterns of abnormal brain activity in depressed patients with vascular risk factors and have implications for the understanding of the pathophysiology of this understudied population.

Objective: To investigate the application value of single-fiber electromyography (SFEMG) on diabetic peripheral neuropathy (DPN). Methods: The values of jitter and fiber density (FD) of extensor digitorum communis muscle in the dominant side in 129 DPN patients were determined by SFEMG. Nerve conduction velocity (NCS) was performed with the routine method. The abnormal detection rate between SFEMG and NCS were compared. The relationship between the values of jitter, the level of glycosylated hemoglobin (HbA 1C) and the prognosis were analyzed. Results: The abnormal detection rate of SFEMG (91.5%) was significantly higher than NCS (78.3%) (P < 0.01). The abnormal detection rate of SFEMG in low increasing HbA 1C level group (86.4%) was significantly higher than NCS (69.7%) (χ 2 = 7.69, P < 0.01), and there was no significantly difference in high increasing HbA 1C level group. There was a positive correlation between the values of jitter and the level of HbA 1C (r = 0.3132, P < 0.05). The effective rate (82.3%) and cure rate (30.6%) in patients with normal or mild abnormal jitter values were significantly higher than the patients with severe abnormal jitter value (54.2%, 11.9%) (χ 2 = 11.02, P < 0.01; χ 2 = 6.32, P < 0.05). Conclusions: SFEMG is valuable for the diagnosis, and also can be used for the judgment of DPN prognosis.

Objective To investigate the risk factors for reduced renal function in patients with ischemic stroke.Methods The medical records of patients with ischemic stroke were analyzed retrospectively.They were divided into normal renal function group and reduced renal function group.Reduced renal function was defined as estimated glomerular filtration rate (eGFR) ＜60 ml/(min·1.73 m2).Multivariate logistic regression analysis was used to identify the risk factors for reduced renal function in patients with ischemic stroke.Results A total of 805 patients with ischemic stroke were enrolled in the study.8.8％ of patients had a reduced renal function.There was no significant differences in the proportion of patients with mild and moderate neurological deficit between the reduced renal function group and the normal renal function group (all P ＞ 0.05),however,the proportion of patients with severe neurological deficit was significantly higher than that in the normal renal function group (8.4％vs.2.6％,x2 =5.573,P =0.017).The proportion of small artery occlusion in the reduced renal function group was sigaificantly higher than that in the normal renal function group (66.2％ vs.46.5％,x2 =9.962,P =0.002),and the proportion of large artery atherosclerosis was significantly lower than that in the normal renal function group (19.7％ vs.43.5％,x2 =15.045,P =0.000).Multivariate logistic regression analysis indicated that old age (odds ratio [ OR] 3.301,95％ confidence interval [ CI],1.575 to 6.918; P=0.002) was the most important independent risk factor for reduced renal function,then was female (OR,2.291,95％ CI 1.355to 3.872; P=0.002) and hyperlipidemia (OR,2.527,95％ CI 1.095 to 5.831; P=0.030).Conclusions Reduced renal function in patients with ischemic stroke is strongly associated with old age,female,and hyperlipidemia.

Objective To observe the effects of ozagrel and aspirin on platelet aggregation and analyze the resistance probability.Methods 120 patients with cerebral infarction were divided randomly into ozagrel group and aspirin group(60 cases in each group),and they were induced by adenosine dophosphact(ADP)and arachidonic acid(AA)respectively.The largest platelet aggregation(MAR)was detected.The platelet aggregation was tested on the first and 14 th day of hospitalization.Results There was no significant difference in platelet aggregation between the two groups induced by the same agents with resistances and semi-resistance phenomenon.Conclusion The difference in effect of ozagrel and aspirin on platelet aggregation is not significant,they can be used as anti-platelet aggregation drug,but there is resistance phenomenon.The further large-scale clinical studies are need to observe the long-term effect of ozagrel on platelet aggregation,and the effect of combination with other anti-platelet aggregation drugs on resistance.

目的分析30例首发失眠改变的甲状腺功能亢进症患者的临床资料,提高对该病的认识。方法 30例患者均以失眠为起病,常规监测三碘甲状腺原氨酸(T3)或游离T3、甲状腺素(T4)或游离T4,促甲状腺素(TSH),与同期原发性失眠症患者60例作对照,对其总睡眠时间、早醒延迟时间、觉醒次数及汉密顿抑郁量表(HAMD)睡眠因子、汉密顿焦虑量表(HAMA)作一评判比较。结果 2组失眠患者:总睡眠时间无差异,早醒延迟时间、觉醒次数及汉密顿抑郁量表(HAMD)睡眠因子、汉密顿焦虑量表(HAMA)评分比较有显著性差异。结论临床对于失眠患者,特别伴激惹、焦虑、紧张、抑郁者应常规监测甲功五项。

Objective To investigate the prevalence of renal impairent and its related risk factors in patients with cerebral infarctions.Methods Totally 902 adult patients with cerebral infarctions were included in this study.Age,sex and blood pressure were recorded.Levels of hemoglobulim,serum cretinine,blood ureanitrogen,blood liqid,serum uric acid were measured.Glomerular filtration rates(GFR) were estimated by the modification of diet in renal disease study equation(MDRD).These cases were divided into three groups:normal group GFR≥90 ml·min-1·(1.73 m2)-1(A group),mild renal insufficiency group 60 ml·min-1·(1.73 m2)-1≤GFR90 ml·min-1·(1.73 m2)-1(B group)and moderate renal insufficiency group GFR60 ml·min-1·(1.73 m2)-1(C group).according to the criterion on classification of GFR in kidney disease outcome quality initiative(K/DOQI).Results The GFR levels of 50.6% of the patients were below 90 ml·min-1·(1.73 m2)-1,and 13.4% were below 60 ml·min-1(·1.73 m2)-1.The incidence rate of chronic kidney disease(CKD)was 25.1%.Elder patients had a higher prevalence than middle-aged patients 8.6%(P0.01);kidney function decline rate were higher in women than in men for both the elder and middle-aged population(P0.001).Binary logistic regression analysis showed that the risk factors for kidney function decline were age,female,smoking,diabetes,coronary atherosclerotic heart disease,hyperuricemic and lipids disorder.Conclusion The prevalence of renal impairment is high in patients with cerebral infarction,and the related risk factors include age,female,smoking,diabetes,coronary artherosclerotic heart disease,lipids disorder and hyperuricemic.

目的:探讨三七皂甙联合阿司匹林预防脑梗死复发的临床疗效。方法:2006年10月至2007年10月江阴市人民医院神经内科住院患者,明确诊断为急性脑梗死患者221例,随机分两组:对照组:阿司匹林100mg,每日一次口服,101例患者(男65例,女56例),观察组:120例患者(男68例,女52例)。三七皂甙片200mg,每日3次口服;阿司匹林100mg,每日1次口服。观察2组1年内缺血性脑卒中的发生率,并于治疗后分别检测组血小板聚集率。结果:观察组1年内脑梗死再发率(5.83%)与对照组相比(17.82%),差异有统计学意义(P<0.05)。治疗后观察组与对照组血小板聚集率相比,差异不具有统计学意义(P>0.05)。结论:三七皂甙与阿司匹林联用,对预防缺血性卒中复发效果优于单用阿司匹林,可能与三七皂甙降低血小板聚集率,减少阿司匹林抵抗有关。